CT abdomen and pelvis with contrast at Banner University Medical Center South. CPT 74177.
What Banner University Medical Center South publishes for this service, straight from its standard-charges file, last updated March 2, 2026.
Outpatient / ER
$419cash price (self-pay)
$3,299list price
$242–$2,639range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Arizona Physicians IPA | Medicaid | $242 |
| Banner University Health Plan | AZ Medicaid - AHCCCS | $242 |
| Banner University Health Plan | University Family Plan | $242 |
| Health Choice Arizona, Inc. | Medicaid | $242 |
| Health Net | Medicaid | $242 |
| Mercy Care | Medicaid | $242 |
| Banner Health | Medicare Advantage | $381 |
| Blue Cross Blue Shield of Arizona | Medicare Advantage | $381 |
| Aetna | Medicare Advantage | $381 |
| Arizona Physicians IPA | Medicare Advantage | $381 |
| Banner University Health Plan | Medicare Advantage | $381 |
| Cigna Healthcare of Arizona, Inc. | HMO Medicare Advantage Plan | $381 |
| Cigna Healthcare of Arizona, Inc. | PPO Medicare Advantage Plan | $381 |
| Gila River Health Care Corporation | Managed Care Program | $381 |
| Health Choice Arizona, Inc. | Medicare Advantage | $381 |
| Health Net | Medicare | $381 |
| Kaiser Foundation Health Plan | Medicare Advantage | $381 |
| Mercy Care | Mercy Care Advantage | $381 |
| Humana | Medicare Advantage | $392 |
| Devoted Health Services | Medicare Advantage | $400 |
| Carelon | Medicare Advantage | $400 |
| Arizona Priority Care | Alignment Health Plans Medicare Advantage/Eter | $419 |
| Gold Kidney Health Plan | Medicare Advantage | $419 |
| Aetna | Banner Employee Plans | $443 |
| NaphCare | Federal | $514 |
| Aetna | Qualified Health Plan | $518 |
| Health Net | Commerical Exchange Product | $563 |
| Health Choice Arizona, Inc. | ACA Health Plan | $571 |
| Blue Cross Blue Shield of Arizona | Medicare Supplemental Senior Prefe | $726 |
| Aetna | Joint Venture | $792 |
Inpatient
$419cash price (self-pay)
$3,299list price
$1,485–$2,639range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| National Healthcare Solutions Inc (NHSI) and VIP Universal Medical Ins | $1,485 |
| Plotkin Health | Plotkin Health | $1,485 |
| Aetna | Medical Rental | $1,739 |
| Quiktrip Corporation | Commercial | $1,781 |
| Provider Network of America | Commercial | $2,474 |
| Arizona Medical Network | Commercial | $2,639 |
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All common services at Banner University Medical Center South